Background <p>Thoracic endometriosis syndrome is an uncommon condition defined by the existence of functional endometrial tissue outside of the uterine cavity, specifically in the pleura, lung parenchyma, or airways. We present a case report of catamenial chest pain and hemothorax, highlighting our personal experience with the diagnosis and management of this rare disease. Our case report covers the pathogenesis, clinical presentation, diagnostic workup, and treatment of thoracic endometriosis syndrome.</p> Case presentation <p>We report a case of a 24-year-old female Black African university graduate who presented with cyclical chest pain and shortness of breath that occurred around the time of her menses. She also experienced severe dysmenorrhea and menorrhagia. Physical examination and imaging studies revealed a right-sided pleural effusion with a chocolate-colored aspirate, suggestive of thoracic endometriosis. The patient was treated with needle thoracocentesis and continuous combined oral contraceptive pills, which led to the resolution of her symptoms. She remains on long-term follow-up.</p> Conclusion <p>This case highlights the challenges of diagnosing and treating thoracic endometriosis syndrome in a low-resource setting. It also underscores the importance of considering this condition in the differential diagnosis of cyclical chest pain and shortness of breath in women of reproductive age. With prompt and appropriate treatment, significant improvement in symptoms can be achieved. Furthermore, despite the challenging local context and the patient’s preference, the managing team strove to provide the patient with a personalized treatment plan, taking into account her unique needs and preferences. This approach to care not only demonstrated a patient-centered approach but also emphasized the importance of effective communication, empathy, and understanding in the healthcare setting.</p>